Healthcare Provider Details

I. General information

NPI: 1568414746
Provider Name (Legal Business Name): JAY EDWARD SELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

V. Phone/Fax

Practice location:
  • Phone: 914-831-2480
  • Fax: 815-366-8194
Mailing address:
  • Phone: 914-831-2480
  • Fax: 815-366-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number120678
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number120678
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number120678
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number120678
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number120678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: